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Jan 20, 2017

Respiratory syncytial virus can be serious in infantsIt’s cold season and that means lots of sneezing, coughing and tissues. Children are most likely to spread and contract a cold virus, but did you know there’s a certain type of virus that is especially dangerous for infants?

Respiratory syncytial virus, commonly known as RSV, is a specific virus that has similar symptoms to the common cold, but causes inflammation of the bronchioles (the smallest of the air passageways in the lungs).

“RSV causes what we call bronchiolitis, which is different than bronchitis,” says LeAnn Kridelbaugh, M.D., President of Children’s Health℠ Pediatric Group. “The difference is that bronchitis is infection or inflammation in the large airways or breathing tubes and RSV affects the bronchioles, which are much tinier breathing tubes. And in young infants, they are very tiny.”

Older children and adults who have RSV may simply notice they have a bad cold. However, in infants or young children who have challenges with lung function for other reasons, RSV can be a challenging and even life-threatening virus.

“When an infant’s breathing tubes get clogged up with mucus, they have trouble getting the air all the way out into the air sacs of the lungs, which is where the work of the lungs happens,” explains Dr. Kridelbaugh.

Does my baby have RSV or just a typical cold?

According to the Centers for Disease Control & Prevention (CDC), RSV is the most common cause of bronchiolitis in children younger than one year of age in the United States. If your baby comes down with symptoms of a cold — such as cough, congestion and fever — you may wonder if it could be RSV. Because RSV is a small airway disease and infants have the smallest airways, it can quickly become serious, especially in babies born prematurely. Your child’s doctor can help determine if it’s RSV.

“What we typically see in young infants with RSV is that they start breathing hard and fast or they look like they’re working hard to breathe,” explains Dr. Kridelbaugh. “It’s not something you hear with your ears, it’s something you see with your eyes. You may see their chest sinking in and their ribs coming and going with each breath, such as how it would look if someone had been running hard.”

There is a test that can be done to diagnose RSV, similar to a swab test done to diagnose influenza. However, most doctors will diagnose RSV based on symptoms. In the hospital, the test is used to help isolate patients with RSV to prevent the spread of the virus to other patients. “In the outpatient setting, there’s not a big reason to test other than to tell the parent what to expect from the virus,” says Dr. Kridelbaugh.

Supportive treatment

If your child is diagnosed with RSV, you can expect the symptoms to last two to three weeks and treatment to focus on supportive care. There is no medication that treats RSV, however, there are things you can do to help keep your infant more comfortable during the illness, including frequent suctioning of their nose to reduce secretions and keeping the air around them humidified so their mucus doesn’t dry out.

Over the counter remedies, including cough medicine and decongestants are not recommended due to evidence that they can cause more harm than good in infants. Your doctor may also use a breathing treatment, including albuterol or a steroid, to help open the airways, however, there is no evidence that these types of treatments are helpful to most children with RSV.

“The current recommendation is that if you have a child with a strong family history of asthma or the child has had wheezing in the past, you may try a breathing treatment and then re-assess the situation,” explains Dr. Kridelbaugh. “However, that’s not for the average baby with RSV.”

In some serious cases, an infant with RSV may need to be hospitalized and put on oxygen, or even transferred to the intensive care unit (ICU) to use a ventilator to force oxygen down into the breathing passages.

“The hardest thing about RSV is that it can be a really bad illness and we don’t have any medication to help make it better,” says Dr. Kridelbaugh. “That’s hard for us as doctors and it’s hard for parents. There’s nothing we can do except support them.”

Preventing RSV

With no specific medicine to treat RSV, it’s vitally important to prevent infants from catching it in the first place. RSV is a seasonal, contagious disease that spreads mostly during the fall, winter and early spring. Typically, RSV is seen in the community and peaks earlier than the flu.

The best way to keep your infant healthy is to keep him or her from being exposed. Adults and other children can transmit RSV, so avoid having the baby around sick people.

“If at all possible, avoid taking your baby out in the winter when they are very tiny because there are lots of things they can be exposed to — including RSV — and they don’t have the resources to deal with it like an older child or adult,” says Dr. Kridelbaugh.

It’s best to keep your baby at home if they become sick so they will not spread the illness to other children. If you can, avoid nurseries, play dates or other group settings while your infant is still very small.